Bill Text: HI SB1140 | 2010 | Regular Session | Amended
Bill Title: Health Plan Payments; Critical Access Hospitals; Federally Qualified Health Centers
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2009-05-11 - Carried over to 2010 Regular Session. [SB1140 Detail]
Download: Hawaii-2010-SB1140-Amended.html
Report Title:
Health Plan Payments; Critical Access Hospitals; Federally Qualified Health Centers
Description:
Requires all health plans in the State, including government payors, to pay to critical access hospitals no less than % of costs for all services provided to plan beneficiaries, and to pay to federally qualified health centers no less than their respective prospective payment system rates. (SB1140 HD2)
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THE SENATE |
S.B. NO. |
1140 |
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TWENTY-FIFTH LEGISLATURE, 2009 |
S.D. 2 |
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STATE OF HAWAII |
H.D. 2 |
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A BILL FOR AN ACT
RELATING TO HEALTH CARE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that rural hospitals and federally qualified health centers are essential to the State's health care system. All health care providers are affected by low reimbursement rates, but rural hospital facilities and publicly supported health centers that serve the economically disadvantaged are especially neglected because of the high cost of providing health care in remote areas with low patient volume and providing comprehensive care to underserved populations with complex health and socio-economic needs. In recognition of these difficulties, the federal government created critical access hospitals and federally qualified health centers to assist the states with improving access to essential health care services.
Critical access hospitals and federally qualified health centers serve those who are covered under the medicare and medicaid programs as well as those with other types of health coverage. State and federal law determine the reimbursement rates for medicare and medicaid provided services. The federal Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, pays critical access hospitals one hundred and one per cent of costs for acute care service to medicare recipients. The state department of human services also calculates payments to critical access hospitals for services to medicaid beneficiaries based on the actual cost of the service. Pursuant to state and federal law, reimbursements for medicaid services reflect both an estimated average cost and the actual cost of providing services, with the State making up the difference between managed care payments and the federal reimbursement rate.
The purpose of this Act is to require health plans, including government payors, and limited benefit health insurance policy insurers, licensed to do business in this State, to reimburse critical access hospitals and federally qualified health centers at rates consistent with medicare and medicaid reimbursement rates.
SECTION 2. Chapter 431, article 10A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§431:10A- Cost-based payments to critical access hospitals and federally qualified health centers. (a) Health insurers shall reimburse critical access hospitals as defined in section 346D-1 at a rate not less than per cent of costs, consistent with the medicare reimbursement rate for all services rendered to health plan beneficiaries.
(b) Health insurers shall pay federally qualified health centers as defined in Section 1905(l) of the Social Security Act (42 U.S.C. 1396d) no less than their respective prospective payment system rates determined pursuant to sections 346-53.6 to 346-53.64.
(c) Nothing in this section shall be construed to determine a maximum amount that a health insurer may pay to a critical access hospital or federally qualified health center for services to plan beneficiaries.
(d) The commissioner may adopt rules pursuant to chapter 91 to effectuate the purpose of this section. The commissioner may require health insurers to annually demonstrate compliance with this section, including validation of payment rates in accordance with medicare interim rate letters.
The commissioner may require critical access hospitals and federally qualified health centers to provide information upon request to clarify, supplement, or rebut information supplied by a health insurer; provided that the release of information by a critical access hospital or federally qualified health center shall be subject to the provisions of the Health Insurance Portability and Accountability Act of 1996."
SECTION 3. Chapter 432, article 1, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§432:1- Cost-based payments to critical access hospitals and federally qualified health centers. (a) Mutual benefit societies shall reimburse critical access hospitals as defined in section 346D-1 at a rate not less than per cent of costs, consistent with the medicare reimbursement rate, for all services rendered to health plan beneficiaries.
(b) Mutual benefit societies shall pay federally qualified health centers as defined in Section 1905(l) of the Social Security Act (42 U.S.C. 1396d) no less than their respective prospective payment system rates determined pursuant to sections 346-53.6 to 346-53.64.
(c) Nothing in this section shall be construed to determine a maximum amount that a mutual benefit society may pay to a critical access hospital or federally qualified health center for services to plan beneficiaries.
(d) The commissioner may adopt rules pursuant to chapter 91 to effectuate the purpose of this section. The commissioner may require mutual benefit societies to annually demonstrate compliance with this section, including validation of payment rates in accordance with medicare interim rate letters.
The commissioner may require critical access hospitals and federally qualified health centers to provide information upon request to clarify, supplement, or rebut information supplied by a mutual benefit society; provided that the release of information by a critical access hospital or federally qualified health center shall be subject to the provisions of the Health Insurance Portability and Accountability Act of 1996."
SECTION 4. Chapter 432, article 2, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§432:2- Cost-based payments to critical access hospitals and federally qualified health centers. (a) Fraternal benefit societies shall reimburse critical access hospitals as defined in section 346D-1 at a rate not less than per cent of costs, consistent with the medicare reimbursement rate, for all services rendered to health plan beneficiaries.
(b) Fraternal benefit societies shall pay federally qualified health centers as defined in Section 1905(l) of the Social Security Act (42 U.S.C. 1396d) no less than their respective prospective payment system rates determined pursuant to sections 346-53.6 to 346-53.64.
(c) Nothing in this section shall be construed to determine a maximum amount that a fraternal benefit society may pay to a critical access hospital or federally qualified health center for services to plan beneficiaries.
(d) The commissioner may adopt rules pursuant to chapter 91 to effectuate the purpose of this section. The commissioner may require fraternal benefit societies to annually demonstrate compliance with this section, including validation of payment rates in accordance with medicare interim rate letters.
The commissioner may require critical access hospitals and federally qualified health centers to provide information upon request to clarify, supplement, or rebut information supplied by a fraternal benefit society; provided that the release of information by a critical access hospital or federally qualified health center shall be subject to the provisions of the Health Insurance Portability and Accountability Act of 1996."
SECTION 5. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§432D- Cost-based payments to critical access hospitals and federally qualified health centers. (a) Health maintenance organizations shall reimburse critical access hospitals as defined in section 346D-1 at a rate not less than per cent of costs, consistent with the medicare reimbursement rate, for all services rendered to health plan beneficiaries.
(b) Health maintenance organizations shall pay federally qualified health centers as defined in Section 1905(l) of the Social Security Act (42 U.S.C. 1396d) no less than their respective prospective payment system rates determined pursuant to sections 346-53.6 to 346-53.64.
(c) Nothing in this section shall be construed to determine a maximum amount that a health maintenance organization may pay to a critical access hospital or federally qualified health center for services to plan beneficiaries.
(d) The commissioner may adopt rules pursuant to chapter 91 to effectuate the purpose of this section. The commissioner may require health maintenance organizations to annually demonstrate compliance with this section, including validation of payment rates in accordance with medicare interim rate letters.
The commissioner may require critical access hospitals and federally qualified health centers to provide information upon request to clarify, supplement, or rebut information supplied by a health maintenance organization; provided that the release of information by a critical access hospital or federally qualified health center shall be subject to the provisions of the Health Insurance Portability and Accountability Act of 1996."
SECTION 6. New statutory material is underscored.
SECTION 7. This Act shall take effect on July 1, 2009.
